From the Guidelines
The patient should continue using the hernia belt as the current management approach, given the reducible and infrequent nature of the hernia, as well as the lack of complications or severe symptoms, as supported by recent clinical guidelines 1. The fact that the hernia is reducible, occurs infrequently, and does not descend into the scrotum suggests it is likely a small, uncomplicated hernia. Key points to consider in the management of this patient include:
- The hernia's reducibility and lack of severe symptoms, which indicate a low risk of complications such as incarceration or strangulation
- The patient's ability to easily reduce the hernia himself without issues, which suggests that the hernia is not causing significant discomfort or impairment
- The use of a hernia belt, which provides external support to the abdominal wall and can help prevent protrusion of abdominal contents through the weakened area As noted in a recent clinical update 1, small, reducible hernias can be managed conservatively with a hernia belt, and elective repair is generally reserved for patients with significant symptoms, pouching issues, or recurrent bowel obstruction. Regular follow-up is recommended to monitor for any changes in the hernia's characteristics or symptoms, and the patient should be advised to seek immediate medical attention if he experiences sudden severe pain, inability to reduce the hernia, nausea, vomiting, or abdominal distension, as these could indicate hernia incarceration or strangulation requiring urgent surgical intervention.
From the Research
Patient Assessment and Recommendations
- The patient is a 39-year-old male with complaints of hernia discomfort, but he can always reduce his hernia without any issues and it does not happen frequently.
- Upon assessment, the hernia could not be palpated, and the patient denies the hernia descending to the scrotum.
- The patient was recommended to continue using his hernia belt.
Risks and Considerations
- Studies have shown that incarceration and strangulation of hernias are associated with significant morbidity and mortality, especially in older patients 2, 3, 4.
- Elective repair of groin hernias is recommended to avoid these complications 2, 3, 4.
- The patient's age and ability to reduce the hernia without issues may indicate a lower risk, but regular monitoring and consideration of surgical options should be discussed 5.
Surgical Options and Considerations
- Laparoscopic or endoscopic procedures are preferable for hernias in women and for bilateral hernias, as they result in less chronic pain 6, 5.
- For primary unilateral hernias in men, open surgery or laparoscopy/endoscopy can be considered, with the choice of procedure depending on individual patient factors and surgeon expertise 5.
- Mesh-based repair is generally recommended due to the pathogenesis of the condition involving an abnormality of the extracellular matrix 5.